Spoiling pleasure: why we should be angry about the UK Chief Medical Officers Alcohol Guidelines Review

Today, the UK government has controversially published revised guidelines on safe drinking levels which see the recommended limits for men fall to 14 units a week, down from 21. The recommendations for women stay at 14. [You can access the report here.]

As wine lovers, we should be angry about this. Not because it’s telling us something we don’t want to hear, but because it is based on a highly questionable interpretation of the data. It seems as if the scientists and civil servants at the Department of Health are on a crusade to stop us drinking. They have an anti-alcohol agenda and this has led to a particular interpretation of the scientific literature on drinking and health which is, to put it bluntly, unprofessional and veering towards incompetent. In essence, we are looking at neo-prohibitionism manifesting itself in the guise of public health.

Drinking, when not to excess, is pleasurable and life-enhancing. Sharing a bottle of wine with a meal is a great pleasure. Drinking a negroni with a friend is a joy. Having a beer with a mate is life-enhancing. Alcohol, used correctly, is one of nature’s great gifts to humanity. Wine is deeply embedded within European culture, and it’s a rich, engaging part of life.

Alcohol abuse is terrible. Sharing a bottle of wine with a meal every night is not alcohol abuse. But this message from the government is evil in its intent: it wants to strip us of this joy, and make us feel guilty about doing something that is part of the pleasure of life. For no good reason. It smacks of control. Why would you want to take away fun from people, and then lie to them about why you are doing it? Can the government scientists really stand behind their conclusions as professionals? What is their real motivation?

So, let’s look at the science. The thorn in the side of neo-prohibitionists is the consistent observation that in Western populations moderate drinkers live longer than non-drinkers, who in turn live longer than heavy drinkers. This is called the ‘J-shaped curve’. It’s a consistent finding in what is known as “epidemiological” studies—those that look at the incidence and distribution of diseases, and their causal factors.

The J-shape refers to the curve on a graph you get if plot mortality (the risk of dying) against alcohol consumption. Moderate drinking increases life expectancy, mainly through its protective effects on the cardiovascular system—your heart and blood vessels. Heavy drinkers also enjoy this benefit, but their risk of death starts to increase because they are more likely to suffer from the various conditions related to heavy drinking, such as cirrhosis of the liver, stroke, certain cancers, and increased risk of accidental or violent death. It is a pretty robust finding that has been replicated in countless studies to the degree that it is no longer controversial.

It’s also quite a significant effect: one large study looking at research spanning back 25 years on the subject indicates that moderate drinkers cut their risk of heart attack by as much as one-quarter.

This message was reinforced by two papers published in the British Medical Journal in 2011, both from William Ghali and colleagues. These papers represented what is known as a meta-analysis, which is a study that attempts to bring together all published evidence on a particular subject from the medical literature in order to draw a more robust conclusion. In the first paper, Ghali carried out a review of the literature looking at studies that had examined the effect of alcohol consumption on biomarkers of coronary disease. They screened almost 5,000 articles, and included the results from 44, which were the relevant studies that met their criteria for suitable data. Overall, 13 biomarkers were included in the analysis. Alcohol was shown to significantly increase high-density lipoprotein (HDL) cholesterol, with a dose–response relationship, and it decreased fibrinogen levels. It didn’t change triglyceride levels but it increased adiponecting and apoplipoprotein A1. All of these changes are reported to be cardioprotective. The authors noted that these changes are “well within a pharmacologically relevant magnitude,” meaning that alcohol is acting as a prescribed medicine might. They point out that the degree of HDL cholesterol increase is better than can be achieved with any single therapy. Alcohol, consumed moderately, seems to be acting as a good drug.

The second paper looked at selected cardiovascular disease outcomes. It examined 4,235 studies, and 84 turned out to be suitable for inclusion in the meta-analysis. The results examined the relative risk of dying for drinkers versus nondrinkers, and once again came up with some significant results. A moderate drinker has 0.75 risk of dying of cardiovascular disease compared with a nondrinker, and 0.71 risk of incident coronary heart disease. An alcohol consumption of 2.5–14.9 g/day (roughly one or two drinks) results in a 14–25% reduction of risk of cardiovascular disease compared with abstainers. Both studies together suggest that alcohol may be having a causal role here: there is a dose–response relationship, and the association is specific, in that alcohol is not uniformly protective for other diseases, such as cancer.

I don’t drink because I think it’s healthy. But to deny this body of scientific evidence in order to produce a simple public health message is dishonest.

The other issue is risk. All drinking, we are told, carries a degree of risk. But as the evidence shows, the risk of dying only increases once you pass a certain consumption level. This is where the public health guidelines on healthy drinking should be focusing. And this point will differ for each individual: age, sex, weight, physical condition, psychology and biological make-up will all be factors here. But it is a much higher limit than 14 units.

So we should be angry about this report. We should be angry about being lied to. We should be questioning the motives of people who want to strip others of joy and make them feel guilty about doing something that’s more than just harmless – it’s actually a good thing. And there must be a lot of people within the department of health who realize that this latest set of guidelines are flawed, but who are scared of speaking out against the crazy neo-prohibitionist agenda.

20 comments to Spoiling pleasure: why we should be angry about the UK Chief Medical Officers Alcohol Guidelines Review

Well put. The original limits were plucked out of thin air, it’s been admitted. 2- 3 glasses of home poured wine puts you on 50 units weekly, and I know plenty of people drinking this and MUCH higher levels. The figures quoted in the government guidelines don’t strike me as being either realistic or truthful.

I love guidelines like this. I do wonder how many people in the UK actually pay any attention to things like this at all? I guarantee you that everysingle one of my friends drinks more than 14 units per week. I remember when the whole unit thing was banged down my throat as part of the WSET. I glanced at it, leart it, and then completely disregarded it for the rest of my life up to the present day. If it was ever discussed being made ILLEGAL to drink more than 14 units per week, I would then kick up one hell of a stink and tell the powers that be not to even think about it. And if ever came into law, I would simply move out of the UK…

All very good, but the question remains: why would the CMO be so anti-alcohol? There are different selective readings to be made of existing research, and I’m not clear why the CMO would be pushing a line that is so clearly unpopular. What on earth is the benefit if this is just 21st century puritanism? Alcohol is big business, and the closest thing the UK has to a national sport, so why go after it?

A much more balanced read than the drivel I’ve been seeing in the papers. I suppose if I locked myself in the house and never went out, ate 1,200 cals a day and did an hour on the cross trainer I’d also live longer. Whoopeee.

You should try living in Scotland! We have a bill going to the Parliament which may mean that my wine shop won’t be allowed to have a window display because it is within 200m of a school, yet theoretically a supermarket 201m away from a school would be allowed to promote cases of Stella for £12.

However, I am curious to hear what you or any other scientifically minded person thinks about the attention grabbing claims that *any* level of regular drinking puts the individual at more danger of contracting a number of forms of cancer.

Is this merely a case of “life causes cancer”. In other words that the only way to avoid these diseases is to abstain from bacon, live in an oxygen-free cubicle and be fed nutrients via a drip, or does the research in the gov’s latest report actually stack up?

This is the only point that makes me pause for thought. I’m very clear on the benefits of moderate, regular drinking and the enjoyment it brings, and I have no intention whatsoever of abiding by guidelines that do indeed seem to have an ulterior motive.

But having lost a mother and a close friend, and watched my father and his new wife very nearly go the same way, I am not able to be so glib when it comes to the cancer part. For sure, the apparent risk increases in small increments, but . . .

Good points raised. Adding to that hitting all consumers with guidelines that are already ignored by the people they are really targetting so making this a storm in a teacup. My thought is the are trying to point us towards the bottom of the j curve-maximum benefits. What it doesn’t acknowledge is a) you’re probably still better drinking 30 units than none and b) personal freedom of choice. But I’d be very surprised if you NEED more than 14 to live longer!

I’m a GP and have to work with this stuff. I think an underlying motive for this is that the government has placed a lot of its eggs in the prevention basket. It sees lifestyle modification as a key way to improve health and, importantly, therefore reduce demand on and hence costs in the NHS. Unfortunately I think this idea makes the same mistake as the original thinking behind the NHS – that providing universal health care free at the point of need would lead to a healthier population and virtually do itself out of a job.

Some people will stick to the rules because that’s what they do. Others may through fear or guilt. Many will ignore it and ultimately I think it will make our job harder as people will increasingly ignore medical advice if it seems unrealistic.

If the government were serious about reducing problem drinking they would bite the minimum price bullet. This may not be popular but it would stop the Stella promotions and even at 50p a unit a14% bottle of wine could still be sold for £5.50 and a 12% bottle for £4.50. And when did you last buy a bottle in the UK for less than that?

I can understand why the CMO wants to take some sort of action. There is an epidemic of alcohol-related liver damage among young people with chaotic patterns of drinking. But the one solution that would address this – minimum unit pricing – has been rejected. So they feel they need to tell a simple message that warns people of the harms of excess drinking. Unfortunately this is a mistaken approach.

Yes, any drinking increases risk. But there’s strong evidence that the risk is accompanied by a benefit that outweighs the risk, up to a point

Both these and the previous guidelines do not feature in my decision making on my life style.
I’m concerned however about being lied to. I listened to the asst CMO on the radio today who said in the latest review they have debunked any positive effects of alcohol, which doesn’t square with Jamie’s analysis.
Theoretically I should be able to trust a senior medical professional more but in this case I do not, which then weakens any trust in other messages.

Before this report was published I have been re-assessing my relationship with alcohol by forcing myself to have just 1 day off a week, and it’s not as easy as I would like. So I feel the backlash to this report sounds a lot like climate change denial, – we don’t want to trust what we don’t like to hear?
What would be more helpful is to appreciate where the J curve is for individuals, and also to understand whether even moderate DAILY drinking leads to mild dependency.
In the meantime I’m inclined to adopt a precautionary principle and reduce the frequency and extent of my consumption, and maybe buy better wine to enjoy in moderation?
I might do the same with cheese and chocolate too?

Much as we might rail against what’s been said, it’s a concern that it has.
Imagine your employer’s health insurance company saying your policy is invalid because you’re not adhering to the guidelines.
A low bar has been set and anyone, even if you’re drinking a few glasses of decent wine a day, over it is marginalised as having a “problem”.
It worked remarkably quickly to ostracise smokers over a few short years; could easily do the same for alcohol users.
Might easily be used as an excuse for increased duty, or for refusal for NHS treatment (as is the case for persistent smokers now).
Should have been you’re No.1 prediction for 2016 Jamie; the demonisation of actually drinking the stuff!
Anyone want to open a bottle shop this year? Good luck.

I’d suggest a good part of the reason the Government has backtracked on minimum pricing and gone this route lies with the fact that some of their major donors are intimately connected to the major supermarkets…

Personally,think the guidelines are a load of rubbish,and the CMO would be far better employed concentrating on obesity and lack of exercise than people who enjoy a glass or three of wine every day. But of course it is each individuals right to deny themselves the pleasure of drinking wine if they wish too,but I shall continue to drink about 5 times the weekly limit,as I have done for well over 50 years now.

FWIW,my view is that diet and exercise is far more crucial to living a long healthy life than such ridiculous limits on the consumption of alcohol

Empire building jobsworths getting paid out of the public purse for
A non-job need to continually up the ante in order to remain employed.
The only message that needs to be put out is ‘everything in moderation’.

Jamie,
If you were going to have a stab at what the units per week were, what do you think they should be? I promise I won’t hold you to it, but I think it would inform us non-scientists about the extent of the CMO’s exaggeration.
Cheers,
Rob

Funny thing is, if you look at Sally Davies (the CMO for England) entry in Wikipedia, she’s quoted as saying in 2013 that young women “we know can only take about half the alcohol that men can” and are more prone to liver damage as a result.
So why aren’t they on 7 units a week?